Davis and Jackson applaud us while questioning the value of our study1 because we examined the effectiveness of a multifaceted, comprehensive approach to tele-ICU care. They claim “such study design may invite persistent argument on the value of individual elements of care.” In our article we acknowledged that, because we studied a multifaceted intervention, we could not comment on the effectiveness of its individual components. However, we believe that studies examining the individual components of a tele-ICU approach would face other limitations. For example, if a particular component of an HITB were shown to have no effect on outcomes, when studied in isolation, it would still leave unanswered the question of whether that technology would be a necessary part of an effective, comprehensive HITB.
McCambridge M, Jones K, Paxton H, Baker K, Sussman E, Etchason J. Specific Elements of Teleintensivist Paradigm Require Additional Scrutiny and Justification—Reply. Arch Intern Med. 2010;170(16):1509-1510. doi:10.1001/archinternmed.2010.298